Hospital restricts narcotics in the ER

Lee Memorial Health System has adopted new guidelines for dispensing addicting narcotics to patients in the Emergency Department.

Lee Memorial Hospital, the Lee County Sheriffs Office, the Fort Myers Police Department and Cape Coral Police are teaming up to enforce the 8 new guidelines.

The guidelines stress the importance of using patient history and the new Florida prescription drug monitoring program to make sure that these drugs end up in the right hands.

Lee Memorial is one of just 15 medical institutions in the state to adopt such guidelines.

These are the guidelines:

1. We strive to coordinate the care of patients with chronic or recurrent pain conditions with primary care and specialist doctors.

Management of chronic or recurrent pain is best accomplished by a single primary care provider or pain management specialist. Following your individualized care plan will optimize your treatment, while avoiding overuse of medications associated with abuse or addiction.

2. One doctor should prescribe all your narcotic or controlled medications.

We may prescribe narcotic pain medications on your first ED visit for an acutely painful condition. If you have already received a narcotic pain medication from anther doctor or ED, we will treat your pain with non-narcotic pain medications.

3. Certain chronic and recurrent pain conditions may not be adequately treated using narcotic medications as a mainstay of treatment.

Many non-narcotic medications are useful in treating chronic pain. We avoid prescribing or administering many narcotic medications for chronic or recurrent pain, such as Dilaudid, Demerol, Morphine, Oxycontin, Vicodin and Percocet. These drugs are known to have the highest rates of abuse and addiction and may not be effective in many chronic pain conditions.

4. We will treat worsening of chronic or recurrent pain conditions with non-narcotic medications or we will prescribe pain medication with a lower risk of addiction and misuse when possible. We may only provide enough pain medication to last until you can contact your doctor.

The administration of intravenous and/or intramuscular narcotics or controlled medications in the ER for the treatment of chronic non-cancer related pain is discouraged by the American College of Emergency Physicians, the Florida College of Emergency Physicians, the State of Florida and LMHS.

5. We may access information about a patient's controlled substance prescription history from Florida's Prescription Drug Monitoring Program.

We may ask you about a history of pain medication misuse or substance abuse and may use additional information, such as urine drug testing when deciding your pain treatment. This helps us understand if you have received controlled substances from multiple physicians and can help prevent serious interactions with other medications you might be taking. These measures help us to determine a more appropriate approach to your pain treatment.

6. Prescriptions for controlled medications may only be given to patients who present a valid, government issued photo identification.

Before you receive a controlled medication prescription you may be asked to show a government-issued photo ID, such as a driver's license. This is generally required for ED registration and pharmacies in order to improve patient safety.

7. We will not replace lost, stolen or destroyed prescriptions for controlled medications.

Pain specialists routinely state in pain management contracts with patients that lost or stolen controlled substances will not be replaced. Unfortunately, patients misusing controlled substances frequently report their prescriptions were lost or have been stolen.

8. We will not prescribe or administer methadone.

We will not provide replacement doses of methadone for patients who have missed a dose. Methadone and other long acting opioid medications such as OxyContin require monitoring which the emergency medical provider cannot adequately provide.

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